Echinacea is one of the most popular herbs in America today. Echinacea is a Native American medicinal plant named for the prickly scales in its large conical seed head, which resembles the spines of an angry hedgehog (echinos is Greek for hedgehog).
Archaeologists have found evidence that Native Americans may have used echinacea for more than 400 years to treat infections and wounds, and as a general "cure-all." Throughout history people have used echinacea to treat scarlet fever, syphilis, malaria, blood poisoning, and diphtheria. Although this herb was popular during the 18th and 19th centuries, its use began to decline in the United States after the introduction of antibiotics. Echinacea preparations became increasingly popular in Germany throughout the 20th century. In fact, most of the scientific research on echinacea has been conducted in Germany.
Today, people use echinacea to shorten the duration of the common cold and flu, and reduce symptoms, such as sore throat (pharyngitis), cough, and fever. Many herbalists also recommend echinacea to help boost the immune system and help the body fight infections.
Several laboratory and animal studies suggest that echinacea contains active substances that boost immune function, relieve pain, reduce inflammation, and have hormonal, antiviral, and antioxidant effects. For this reason, professional herbalists may recommend echinacea to treat urinary tract infections, vaginal yeast (candida) infections, ear infections (also known as otitis media), athlete's foot, sinusitis, hay fever (also called allergic rhinitis), as well as slow-healing wounds. Preliminary studies in the lab suggest echinacea may help inhibit colon tumors when combined with cichoric acid. One study even suggests that echinacea extract exerted an antiviral action on the development of recurrent cold sores triggered by the herpes simplex virus (HSVI) when taken prior to infection.
Whether or not echinacea helps prevent or treat the common cold remains controversial. Some studies have shown that the herb can make you feel better faster. Others suggest that echinacea has no impact on a cold at all. Several clinical trials have shown that people who take echinacea as soon as they feel sick reduce the severity of their cold and have fewer symptoms than those who do not take the herb. One study of 95 people with early symptoms of cold and flu (such as runny nose, scratchy throat, and fever) found that those who drank several cups of echinacea tea every day for 5 days felt better sooner than those who drank tea without echinacea.
A review of 14 clinical trials found that echinacea reduced the odds of developing a cold by 58% and the duration of a cold by 1 to 4 days. However, some experts dispute these findings claiming there were several weaknesses in the analyses. Echinacea preparations tested in clinical trials differ greatly. It is important to choose a high-quality echinacea supplement, and to use echinacea as early as possible in the course of a cold, with multiple doses per day for the first few days. Talk to your health care provider for recommendations.
Three species of echinacea are commonly used for medicinal purposes: Echinacea angustifolia, Echinacea pallida, and Echinacea purpurea. Many echinacea preparations contain one, two, or even all three of these species. Different products use different parts of the echinacea plant, which is why the effectiveness of echinacea may differ from one product to another.
Echinacea (including one, two, or all three species) is available in extracts, tinctures, tablets, capsules, and ointments. It is also available in combination with other immune-boosting herbs, vitamins, and minerals.
A study performed by ConsumerLab.com (an independent company that tests the purity of health, wellness, and nutrition products) found that of 11 brands of echinacea purchased for testing, only 4 contained what was stated on their labels. About 10% had no echinacea at all; half were mislabeled as to the species of echinacea in the product; and more than half of the standardized preparations did not contain the labeled amount of active ingredients.
Buy products made by reputable, established companies that distribute their products through trustworthy and knowledgeable establishments. When possible, select products with guaranteed potency or standardized extracts.
The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs contain active substances that may trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs only under the supervision of a health care provider knowledgeable in the field of botanical medicine.
People with tuberculosis, leukemia, diabetes, connective tissue disorders, multiple sclerosis, HIV or AIDS, any autoimmune diseases, or, possibly, liver disorders should not take echinacea. There is some concern that echinacea may reduce the effectiveness of medications that suppress the immune system. For this reason, people receiving organ transplants who must take immunosuppressant medications should avoid this herb.
In rare cases, echinacea may cause allergic reactions, ranging from a mild rash to anaphylaxis (a life-threatening reaction accompanied by throat tightening, shortness of breath, and, possibly fainting). People with asthma and allergies may be at an increased risk for developing these adverse reactions. People with allergies to plants in the daisy family (compositae) should not take Echinacea without the supervision of a provider.
Minor side effects can include stomach upset, nausea, dizziness, and dry eyes.
There has been one report of an individual developing erythema nodosum (a painful skin condition) after taking echinacea to treat the flu.
When taken by mouth, echinacea may cause temporary numbing and tingling on the tongue.
Despite concerns that echinacea may be unsafe for pregnant or breastfeeding women, evidence suggests that the use of echinacea during pregnancy does not increase the risk of birth defects or other pregnancy related health problems. More research is needed. In the meantime, avoid using Echinacea during pregnancy or breastfeeding until more conclusive studies are conducted.
Talk to your doctor if you have questions.
Askeroglu U, Alleyne B, Guyuron B. Pharmaceutical and herbal products that may contribute to dry eyes. Plast Reconstr. Surg. 2013;131(1):159-67.
Auerbach: Auerbach Wilderness Medicine. 5th ed. Philadelphia, PA: Elsevier Mosby; 2007.
Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Echinacea for treating the common cold: a randomized trial. Ann Intern Med. 2010;153(12):769-77.
Borchers AT, Keen CL, Stern JS, Gershwin ME. Inflammation and Native American medicine: the role of botanicals. [Review]. Am J Clin Nutr. 2000 Aug;72(2):339-47.
ConsumerLab.com. Product review: echinacea. Accessed on April 1, 2002.
Di Pierro F, Rapacioli G, Ferrara T, Togni S. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev. 2012;17(1):36-41.
Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. [Review]. Ann Intern Med. 2002;136(1):42-53.
Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med. 2000;6(4):327-34.
Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med. 2000;160:3141-3.
Ghemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, Hassan Z. Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. Intervirology. 2009;52(1):29-34.
Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. 2004;29(1):75-83.
Haller J, Hohmann J, Freund TF. The effect of Echinacea preparations in three laboratory tests of anxiety: comparison with chlordiazepoxide. Phytother Res. 2010;24(11):1605-1.
Islam J, Carter R. Use of Echinacea in upper respiratory tract infection. South Med J. 2005;98(3):311-8.
Karsch-Volk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2:CD000530.
Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2006;1:CD000530.
Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med. 2000;6(4):327-34.
Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. 2001;4(4):199-208.
Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. [Review]. Cochrane Database Syst Rev. 2000;2:CD000530.
Miller. Miller's Anesthesia. 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.
Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol. 2002;88(1):42-51.
Nahas R, Balla A. Complementary and alternative medicine for prevention and treatment of the common cold. Can Fam Physician. 2011;57(1):31-6.
Naser B, Lund B, Henneicke-von Zepelin HH, Kohler G, Lehmacher W, Scaglione F. A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Phytomedicine. 2005;12(10):715-22.
Percival SS. Use of echinacea in medicine. [Review]. Biochem Pharmacol. 2000;60(2):155-8.
Rakel. Rakel: Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.
Schapowal A. Efficacy and safety of Echinaforce in respiratory tract infections. Wien Med Wochenschr. 2013;163(3-4):102-5.
Schwarz E, Parlesak A, Henneicke-von Zepelin HH, Bode JC, Bode C. Effect of oral administration of freshly pressed juice of Echinacea purpurea on the number of various subpopulations of B- and T-lymphocytes in healthy volunteers: results of a double-blind, placebo-controlled cross-over study. Phytomedicine. 2005;12(9):625-31.
Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007;7(7):473-80. Review.
Sharma M, Schoop R, Suter A, Hudson JB. The potential use of Echinacea in acne: control of Propionibacterium acnes growth and inflammation. Phytother Res. 2011;25(4):517-21.
Soon SL, Crawford RI. Recurrent erythema nodosum associated with Echinacea herbal therapy. J Am Acad Dermatol. 2001;44(2):298-9.
Summaries for patients. Echinacea for the common cold. Ann Intern Med. 2010 Dec;153(12):1-43.
Taheri JB, Azimi S, Rafieian N, Akhaven Zanjani H. Herbs in dentistry. Int Dent J. 2011;61(6):287-96.
Tsai YL, Chiu CC, Yi-Fu Chen J, Chan KC, Lin SD. Cytotoxic effects of Echinacea purpurea flower extracts and cichoric acid on human colon cancer cells through induction of apoptosis. J Ethnopharmacol. 2012;143(3):914-9.
Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother. 2000;44:1708-9.
Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. 2005;353(4):341-8.
von Maxen A, Schoenhoefer P. Benefit of echinacea in the prevention and treatment of the common cold? The Lancet Infectious Disease. 2008;8(6).
Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C. Echinacea purpurea for prevention of upper respiratory tract infections in children. J Altern Complement Med. 2005;11(6):1021-6.
Woelkart K, Marth E, Suter A, et al. Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. Int J Clin Pharmacol Ther. 2006;44(9):401-8.
Yamada K, Hung P, Park TK, Park PJ, Lim BO. A comparison of the immunostimulatory effects of the medicinal herbs Echinacea, Ashwagandha and Brahmi. J Ethnopharmacol. 2011;137(1):231-5.